International Comparison

America’s Health Rankings Annual Report presents national benchmarks and examines the relative health of the 50 states and the District of Columbia. In this section, we broaden our scope to evaluate how U.S. population health compares with member countries of the Organization for Economic Cooperation and Development (OECD). Thirty-six countries, including the United States, comprise the OECD. The organization’s mission is to promote economic development and social well-being of people worldwide. The OECD collects and analyzes data from each of the member countries on a wide range of social, economic and health-related topics.

The following international perspective offers insight into the extent of state-to-state variation and how the health of the U.S. compares with the health of its peers. This analysis compares the top state, bottom state and national average for three key population health measures with OECD member countries.

Results show the U.S. experiences a higher infant mortality rate, a higher prevalence of obesity and a lower life expectancy compared with most OECD member countries. Even the top U.S. state in each of these measures ranks toward the bottom among OECD countries.

According to this year’s America’s Health Ranking Annual Report, the U.S. infant mortality rate is 5.9 deaths per 1,000 live infant births, while the average rate of infant mortality among the OECD countries is 3.9 deaths per 1,000 live births. Compared with other OECD countries, the U.S. ranks No. 33 out of 36 countries (Figure 62). Iceland is ranked No. 1 and has the lowest rate with 0.7 deaths per 1,000 live births. Mexico is ranked last with 12.1 deaths per 1,000 live births. New Hampshire and Vermont are tied for the top state in the U.S. with 3.9 deaths per 1,000 live births. These two neighboring states have achieved an infant mortality rate equal to the OECD average. As the bottom-ranked state, however, Mississippi has an infant mortality rate more than twice that of the OECD average at 8.9 deaths per 1,000 live births and internationally ranks below all but two of the OECD countries. Over the past 50 years, the decline in the U.S. infant mortality rate has not kept pace with that in other OECD countries. When examining sex- and age-adjusted infant mortality rates from 2001 to 2010, the U.S. rate was 75 percent higher than the average rate in 20 OECD comparable countries.

The prevalence of obesity has been increasing over the past four decades in the U.S. This trend has also been observed internationally and is projected to continue. Obesity has increased 13 percent since 2012 in the U.S., with nearly a third of the population self-reporting obesity as of 2018. Among the 31 OECD countries with self-reported obesity data available, the U.S. ranks last (Figure 63). Colorado, the top-ranked state in the U.S., has an obesity prevalence of 22.6 percent, which is still higher than the OECD country with the second-highest obesity prevalence (Hungary, 21.2 percent). West Virginia, the least healthy state, has nearly 40 percent of the population reporting obesity, which is 12 times higher than the OECD country with the lowest obesity prevalence (Korea, 3.2 percent).

The U.S. life expectancy at birth of 78.6 years ranks No. 28 out of 36 OECD countries, below the Czech Republic (79.1 years) and above Poland and Turkey (tied at 78.0 years). Hawaii, the state with the highest life expectancy in the U.S. at 81.3 years, is tied with Slovenia at No. 21. Mississippi, ths state with the lowest life expectancy of 75 years, falls just above Lithuania (No. 35, 74.8 years) and Latvia (No. 36, 74.7 years).